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Fetal therapy raises ethical concerns in relation to the balance of potential benefit and harm, autonomy and informed consent, and the duties of the clinician to the pregnant women and fetus. Invasive therapy should be recommended only when it has a realistic chance of saving the life of the fetus and offspring or preventing serious and irreversible disease or disability. Clinicians should respect maternal choice and assessment of risk, particularly if the therapy might be only partially successful, leaving the offspring with a profound morbidity. Fetal therapy should not be undertaken without maternal consent; nor should it be presented coercively as an option to avoid a termination of pregnancy. Therapeutic procedures of unproven efficacy should be undertaken only with the voluntary informed consent of the pregnant woman and according to a clearly defined research protocol that has been approved by an appropriate research ethics committee and where appropriate support and counselling can be provided.

Objective: To present the outcome of a consecutive series of 19 fetuses referred to our center for megacystis in the first half of the pregnancy., Study Design: Retrospective analysis., Methods: 19 cases of early fetal megacystis were reviewed. Inclusion criteria were the visualization of an enlarged bladder with a maximum longitudinal diameter >10 mm and a gestational age of no more than 19 weeks., Results: The median gestational age at diagnosis was 16 weeks (range 12-19 weeks). The median maximum longitudinal diameter of the fetal bladder at the time of diagnosis was 21 mm (range 11-35 mm). The fetal megacystis was associated with another extra renal anomaly in six cases (30%). There was no fetus with abnormal karyotype. Termination of pregnancy was performed in 11 cases because of the severity of the renal disease. One spontaneous intrauterine death occurred. A vesicoamniotic shunt was inserted in three cases, two of which died in utero. The surviving fetus that was shunted died in the neonatal period from acute renal failure. In the remaining four fetuses, resolution of the megacystis occurred spontaneously (n = 2) or following serial single-needle aspiration (n = 2). One of these had renal insufficiency requiring kidney transplantation., Conclusion: The outcome of fetuses with early obstructive uropathy is poor, with or without in utero therapy. Pathophysiology, clinical presentation and outcome of fetuses with early uropathy may differ from those previously described in the latter part of pregnancy., (Copyright 2003 John Wiley & Sons, Ltd.)

Objective: Duchenne muscular dystrophy (DMD) is a lethal degenerative muscular disease. Fetal gene therapy may correct the primary genetic defect. Our aim was to achieve expression of a reporter gene in the respiratory muscles of early gestation fetal sheep. Study design: An adenovirus vector containing the β-galactosidase reporter gene (AdRSVβgal) was injected into the thoracic musculature (n = 3) and pleural cavity (n = 6) of fetal sheep (61-67 days' gestation) under ultrasound guidance. Tissues were harvested after 48 hours and site and intensity of β-galactosidase expression were assessed. Results: Limited transgene expression observed after a single injection was improved by multiple injections, but remained localized. Ultrasound-guided creation of a hydrothorax led to an increase in the intensity of β-galactosidase expression (ELISA). X-gal staining and immunohistochemistry showed that vector spread was confined to the innermost intercostal musculature. Conclusion: Ultrasound-guided injection can deliver gene therapy vectors to the fetal pleural cavity and achieve transduction of the respiratory muscles. [ABSTRACT FROM AUTHOR]

To objectively measure individual recreational drug groups in maternal hair samples timed for the period of conception and different stages of pregnancy in expectant mothers with a diagnosis of fetal gastroschisis. Prospective observational study. Tertiary level Fetal Medicine Unit in a University teaching hospital. Pregnant women with a diagnosis of fetal gastroschisis ( n= 22) and a control group of women ( n= 25) with a normal fetus. Hair samples were cut from the vertex of the head of expectant mothers with a diagnosis of fetal gastroschisis and a matched control group in whom the fetus was normal. The samples were analysed by enzyme-linked immunosorbent assay (ELISA) for individual drug groups. Confirmatory tests using gas chromatography with mass spectrometry (GCMS) were used. Presence of recreational drug compounds in hair samples. In the group with fetal gastroschisis there were four proven positive cases for recreational drug abuse (18%) and there were none in the control group. The incidence of recreational drug use in the peri-conceptional period and the first trimester by expectant mothers with a diagnosis of fetal gastroschisis is 18%. This association may be linked to the recent increase in the incidence of gastroschisis among younger mothers. [ABSTRACT FROM AUTHOR]

Presents an experts' forum on prenatal management of alloimmune thrombocytopenia of the fetus. Risk factors for severe alloimmune thrombocytopenia; Prediction of severe alloimmune thrombocytopenia using a non-invasive technique; Treatment strategies.